| NPI | 1184918476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD423670) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PA MD423670) |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2015-12-30 |