| NPI | 1871564179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 63023) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: SC 34025) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: AL 16713) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: NC 182342) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2015-12-17 |