| NPI | 1609301779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MS 29686) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 31052) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2023-07-25 |