| NPI | 1447411012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CT 63976) |
| Additional Taxonomies | 207ZP0104X Pathology Chemical Pathology (Licence: RI LP01341) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2021-11-23 |