| NPI | 1568420396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX H7750) |
| Additional Taxonomies | 207ZF0201X Pathology Forensic Pathology (Licence: TX H7750) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2007-07-15 |