| NPI | 1912959792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: UT 1869991205) |
| Additional Taxonomies | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: UT 1869991205) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2007-07-08 |