| NPI | 1710277447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NE 30562) |
| Additional Taxonomies | 207ZN0500X Pathology Neuropathology (Licence: RI LP03271) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: IA MD-45371) | |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2021-07-13 |