| NPI | 1033282967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WI 28823) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: WI 28823-20) |
| 208D00000X General Practice (Licence: WI 28823-20) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2017-02-16 |