| NPI | 1285892364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AL 26966) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: AL 26966) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: AL 26966) | |
| 208D00000X General Practice (Licence: TX P1022) | |
| 209800000X Legal Medicine (Licence: AL 26966) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2021-05-12 |