| NPI | 1720284623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OR MD26443) |
| Additional Taxonomies | 207ZN0500X Pathology, Neuropathology (Licence: OR MD26443) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA WA00049209) | |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2012-02-08 |