| NPI | 1861516718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: VA 0101231713) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: DC MD32177) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA A63118) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MD D0058140) | |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2023-08-01 |