| NPI | 1053381699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WI 40492) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: WI 40492) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2019-09-13 |