| NPI | 1386629491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101259551) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD028063E) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: HI MD-8017) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2022-07-21 |