| NPI | 1356365506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2006029248) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: MO 2006029248) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-04-20 |