NPI | 1972769768 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NJ 25MA9045700) |
Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: PA MT 189556) |
Enumeration Date | 2008-08-01 |
Last Update Date | 2021-12-30 |