| NPI | 1942487251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: TN 46700) |
| Additional Taxonomies | 207ZP0101X Pathology Anatomic Pathology (Licence: GA 002694) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2020-06-02 |