| NPI | 1578510293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN MD23934) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 025276) |
| 174400000X Specialist (Licence: AR R-4416) | |
| 174400000X Specialist (Licence: TN MD23934) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CT 025276) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AR R-4416) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2018-02-22 |