| NPI | 1518552603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246Q00000X Specialist/Technologist, Pathology |
| Additional Taxonomies | 246RH0600X Technician, Pathology Histology |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-01 |