| NPI | 1497118608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NC 2009-01833) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 2009-01833) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2016-04-04 |