| NPI | 1285695858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 9600750) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: TN 44D2033773) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2013-08-22 |