| NPI | 1609214493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 28111) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MT 117949) |
| 208D00000X General Practice (Licence: NE 28111) | |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2023-01-12 |