| NPI | 1639246366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: GA 053337) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: GA 053337) |
| 174400000X Specialist (Licence: FL ME89563) | |
| 174400000X Specialist (Licence: LA MD07816R) | |
| 174400000X Specialist (Licence: TX H9386) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2017-04-06 |