| NPI | 1568453785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NY 189564) |
| Additional Taxonomies | 207ZB0001X Pathology, Blood Banking & Transfusion Medicine (Licence: NY 189564) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 189564) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2009-11-30 |