| NPI | 1811170400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA A71874) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: CA 05D1098267) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2024-07-06 |