| NPI | 1063570232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IN 01055152A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01055152A) |
| 174400000X Specialist (Licence: IN 01055152A) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-11-24 |