| NPI | 1083820021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH 35.093176) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2020-01-30 |