| NPI | 1205056421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MO 2009001447) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MO 2006016382) |
| Enumeration Date | 2007-04-27 |
| Last Update Date | 2010-02-08 |