| NPI | 1811011448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AL 37979) |
| Additional Taxonomies | 207ZC0500X Pathology, Cytopathology (Licence: LA MD.018496) |
| 207ZC0500X Pathology, Cytopathology (Licence: AL 37979) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: LA MD.018496) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2019-05-09 |