| NPI | 1548540834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MO 2011014215) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: IA MD-43445) |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2016-07-20 |