| NPI | 1407171184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PA MD463788) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: NY P10059) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA10534900) | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2024-03-11 |