| NPI | 1265548382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G77431) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: SC 2951) |
| 207ZF0201X Pathology Forensic Pathology (Licence: NC 2005-01895) | |
| 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA G77431) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2015-06-11 |