| NPI | 1568553030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA G30670) |
| Additional Taxonomies | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: CA 05D0896736) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2010-04-23 |