| NPI | 1245297316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NC 971660) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 9701660) |
| 207Q00000X Family Medicine (Licence: SC 18811) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: SC 18811) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2018-11-08 |