| NPI | 1851617237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: TX Q4639) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 267869-1) |
| Enumeration Date | 2010-04-11 |
| Last Update Date | 2021-08-03 |