| NPI | 1548314313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA A106146) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: MD T1602) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2020-02-10 |