| NPI | 1790044816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 8831892-1205) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: UT 8831892-1205) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2017-10-03 |