| NPI | 1548883606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: RI DO01271) |
| Additional Taxonomies | 208D00000X General Practice (Licence: RI DO01271) |
| Enumeration Date | 2020-05-24 |
| Last Update Date | 2023-06-24 |