| NPI | 1780916007 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207ZF0201X Pathology, Forensic Pathology (Licence: CA A110995) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA A 110995) | 
| Enumeration Date | 2010-02-11 | 
| Last Update Date | 2014-08-11 |