| NPI | 1164769485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: TX D6448) |
| Additional Taxonomies | 207ZC0006X Pathology, Clinical Pathology (Licence: TX D6448) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-01-07 |