| NPI | 1063698389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME114502) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: FL ME114502) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: GA 70914) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX P0794) | |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2023-03-07 |