| NPI | 1588031942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MD D0059010) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: CA G77898) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2015-09-01 |