| NPI | 1104130954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 198163) |
| Additional Taxonomies | 207ZP0104X Pathology, Chemical Pathology (Licence: NY 198163) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2013-06-03 |