| NPI | 1356319032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA A24300) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A24300) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2012-08-31 |