| NPI | 1104246263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME150175) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IL 1104246263) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2021-09-07 |