| NPI | 1568648392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX N2656) |
| Additional Taxonomies | 207ZP0007X Pathology, Molecular Genetic Pathology (Licence: TX N2656) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2010-04-05 |