| NPI | 1124188412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MA05200600) |
| Additional Taxonomies | 207ZF0201X Pathology Forensic Pathology (Licence: NJ 25MA05200600) |
| 207ZN0500X Pathology Neuropathology (Licence: NJ 25MA05200600) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA05200600) | |
| 209800000X Legal Medicine (Licence: NJ 25MA05200600) | |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2007-07-08 |