| NPI | 1124456652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZC0006X Pathology, Clinical Pathology (Licence: MA 265631) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: MA 255637) |
| Enumeration Date | 2013-10-18 |
| Last Update Date | 2018-02-14 |