| NPI | 1043848260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX U4809) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH FG3002514) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-05-15 |