| NPI | 1952750564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0213X Pathology Pediatric Pathology (Licence: OH 35.138889) |
| Additional Taxonomies | 251300000X Local Education Agency (LEA) |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2021-06-02 |