| NPI | 1710340385 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NM MD2024-0992)  | 
| Additional Taxonomies | 207ZP0104X Pathology, Chemical Pathology (Licence: NM MD2024-0992)  | 
| Enumeration Date | 2016-03-31 | 
| Last Update Date | 2024-10-03 |