| NPI | 1760680631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: TN 50957) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MO 2007017953) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2014-09-09 |