| NPI | 1952717035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 269782) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 259161) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2017-11-28 |