| NPI | 1700820487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD047282L) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: PA MD047282L) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: NJ 25MA07827100) | |
| 291U00000X Clinical Medical Laboratory (Licence: NY 232717-1) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2022-12-07 |