| NPI | 1083855464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA A94085) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: CA A94085) |
| 207ZD0900X Pathology, Dermatopathology (Licence: CA A94085) | |
| Enumeration Date | 2009-03-16 |
| Last Update Date | 2020-09-22 |