| NPI | 1598962557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA G24929) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PA MD032446E) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 24315) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2015-06-08 |