| NPI | 1417215245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD60765317) |
| Additional Taxonomies | 207ZC0006X Pathology, Clinical Pathology (Licence: WA MD60765317) |
| 207ZD0900X Pathology, Dermatopathology (Licence: WA MD60765317) | |
| 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WA MD60765317) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2025-08-07 |