| NPI | 1104874122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WI 35342-20) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WI 35342) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-10-13 |