| NPI | 1063845550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NY 293264) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA10678100) |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2021-03-08 |