| NPI | 1609088814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AL 12621) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: AL 12621) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: AL 12621) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |