| NPI | 1114140233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA A98537) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A98537) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2017-03-28 |