| NPI | 1972594158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 7669) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: AZ 7669) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2010-11-17 |