| NPI | 1649807108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD61673532) |
| Additional Taxonomies | 207ZC0006X Pathology, Clinical Pathology (Licence: WA MD61673532) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD61673532) | |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2025-07-24 |