| NPI | 1457372831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NM MD2011-0113) |
| Additional Taxonomies | 208D00000X General Practice (Licence: ND 10084) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-08-14 |