| NPI | 1326509977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX U4750) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX U4750) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2023-07-27 |