| NPI | 1962408534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: PA MD038051E) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: PA MD038051E) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2019-08-23 |