| NPI | 1558928721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0104X Pathology Chemical Pathology (Licence: VA 0101282632) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: RI LP04585) |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2024-08-09 |