| NPI | 1790103521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AR E-11231) |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: OK 38609) |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2022-10-24 |