| NPI | 1922002492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TX H9743) |
| Additional Taxonomies | 207ZF0201X Pathology Forensic Pathology (Licence: TX H9743) |
| 202C00000X Independent Medical Examiner (Licence: TX H9743) | |
| Enumeration Date | 2005-06-11 |
| Last Update Date | 2017-01-10 |