| NPI | 1053418947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA A26610) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: CA A26610) |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: CA A26610) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-06-18 |