| NPI | 1598767758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: VA 0102208087) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA OS-004906L) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2023-10-12 |