| NPI | 1477847572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 81748-20) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 29384) |
| 208D00000X General Practice (Licence: VA 0101252365) | |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2023-06-14 |