| NPI | 1326307430 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: CA A136853) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT201112) | 
| Enumeration Date | 2012-05-09 | 
| Last Update Date | 2021-05-19 |