| NPI | 1821199571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 33968) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: GA 32223) |
| 291U00000X Clinical Medical Laboratory (Licence: AL MD.30846) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-12-03 |