| NPI | 1871527184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: LA MD.199952) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OR MD 27735) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WA MD 00048490) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2009-04-24 |