| NPI | 1033405584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA A131722) |
| Additional Taxonomies | 1744R1102X Specialist Research Study (Licence: CA T32HL116273) |
| 207R00000X Internal Medicine (Licence: PA MT198953) | |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CA 115994) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2022-01-04 |