| NPI | 1992797443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: KY 26846) |
| Additional Taxonomies | 207ZN0500X Pathology Neuropathology (Licence: KY 0028646) |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: OH 35059201) | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2008-03-05 |