| NPI | 1548315484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MN 53493) |
| Additional Taxonomies | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: MN 18372) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: ND 13352) | |
| 207ZC0500X Pathology Cytopathology (Licence: MN 53493) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-12-19 |