| NPI | 1316947195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX J5315) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX J5315) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2024-10-03 |