| NPI | 1356565220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME9631) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: FL me 9631) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2015-08-17 |