| NPI | 1639155971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: SC 14834) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: NC 38927) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NC 38927) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 14834) | |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2016-07-01 |