| NPI | 1407907207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VT 060-0003385) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: MN 53085) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2011-07-20 |