| NPI | 1700840634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZF0201X Pathology Forensic Pathology (Licence: TX G4626) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX G4626) |
| 2083P0901X Preventive Medicine Public Health & General Preventive Medicine (Licence: TX G4626) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-08 |