| NPI | 1063401743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME136304) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD046725L) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA06129300) | |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2023-06-23 |