| NPI | 1033100847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD054610L) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX N4830) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SD 7949) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IA MD-43140) | |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2016-03-10 |