| NPI | 1548246259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME107816) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 52008) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2012-01-13 |