| NPI | 1053723833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: CA C201107) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: CA C201107) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2025-07-10 |