| NPI | 1831273077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OR MD 10083) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD 10973) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA G25292) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |