| NPI | 1710078654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: MN 29005) |
| Additional Taxonomies | 207ZC0500X Pathology Cytopathology (Licence: MN MN29005) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-10-02 |