| NPI | 1154577633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: KY 48043) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: FL 120499) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 56127) | |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2020-10-13 |