| NPI | 1740575125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MN 62189) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: IL 125059986) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2022-07-21 |