| NPI | 1598004939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX Q6075) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: TX Q6075) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2019-08-07 |