| NPI | 1174774582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: CA C170530) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 73725) |
| 207ZN0500X Pathology, Neuropathology (Licence: PA MD058200L) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2026-08-04 |