NPI | 1093891079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 145218) |
Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 145218) |
Enumeration Date | 2006-10-31 |
Last Update Date | 2008-07-29 |