| NPI | 1184790669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 256741) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME83983) |
| 207Q00000X Family Medicine (Licence: NY 256741) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME83983) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-07-06 |