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 |