| NPI | 1508058678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NV 12724) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CO 38786) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NM 83-190) | |
| Enumeration Date | 2007-08-13 |
| Last Update Date | 2012-07-05 |