| NPI | 1679534432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: WY 9164A) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: MN 27443) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: MN 27443) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: ID M-12068) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2020-11-20 |