| NPI | 1710909080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: LA MD012724) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX 41158) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: LA MD12724) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2008-04-30 |