| NPI | 1306946116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX M7459) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD00047088) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 37363) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-02-03 |