| NPI | 1023256708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IA 16396) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: IA 16396) |
| 207Q00000X Family Medicine (Licence: IL 036.084486) | |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2009-10-07 |