| NPI | 1659460897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA G156025) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: WA MD00028232) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-09-09 |