| NPI | 1699017814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MD D0023119) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: CA G48301) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2016-02-09 |