| NPI | 1215994389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NE 14967) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: NE 14967) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2011-06-23 |