| NPI | 1639508484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 267565) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 256524) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2017-05-23 |