| NPI | 1629264197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: CO DR.0066883) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX N3191) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: TX N3191) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN resident) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2022-03-02 |