| NPI | 1508278532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME132723) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME132723) |
| Enumeration Date | 2014-05-26 |
| Last Update Date | 2019-06-04 |