| NPI | 1124135074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301405438) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: MI 405438) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 405438) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2017-01-11 |