| NPI | 1134550643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: CA A170171) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MO 2013021210) |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2020-10-15 |