| NPI | 1902920614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME83032) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: GA 050356) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MA 80068) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |