| NPI | 1629301700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA A 107094) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA A107094) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2024-03-28 |