| NPI | 1801106836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 194723) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: WI 39871) |
| 208D00000X General Practice (Licence: NY 194723-1) | |
| Enumeration Date | 2010-10-08 |
| Last Update Date | 2017-11-06 |