| NPI | 1619170552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME101330) |
| Additional Taxonomies | 207ZD0900X Pathology, Dermatopathology (Licence: AL 25024) |
| 207ZH0000X Pathology, Hematology (Licence: FL ME 101330) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL 101330) | |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2016-02-11 |