| NPI | 1558709352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: CO DR.0068949) |
| Additional Taxonomies | 207ZB0001X Pathology Blood Banking & Transfusion Medicine (Licence: NE 1337) |
| 208D00000X General Practice (Licence: TX BP10048437) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2022-11-01 |