| NPI | 1336481480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CT 73522) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101266562) |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 69409-20) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2023-03-01 |