| NPI | 1205885266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 13579) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NE 13579) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2011-06-24 |