| NPI | 1922362516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME142554) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: LA 307544) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2019-11-20 |