| NPI | 1366569618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX F8447) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX F8447) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2024-06-28 |