| NPI | 1083947113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: OR 7776) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: WA 34470) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2009-09-08 |