| NPI | 1871944884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: TX T5611) |
| Additional Taxonomies | 207ZN0500X Pathology Neuropathology (Licence: TX T5611) |
| 207ZP0101X Pathology Anatomic Pathology (Licence: MO 2016014588) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2022-03-31 |