| NPI | 1154447993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MO 2003024385) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: TN 43780) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2021-08-19 |