| NPI | 1114364528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WI 66680-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN18887) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2019-05-30 |