| NPI | 1417199704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NC 2017-00590) |
| Additional Taxonomies | 207ZF0201X Pathology Forensic Pathology (Licence: NC 2017-00590) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2017-12-13 |