| NPI | 1174774582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MA 73725) |
| Additional Taxonomies | 207ZN0500X Pathology Neuropathology (Licence: PA MD058200L) |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2017-02-02 |