| NPI | 1649219130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WI 34555-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: HI 20808) |
| 208D00000X General Practice (Licence: HI MD-20808) | |
| 208D00000X General Practice (Licence: WI 34555-20) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-07-13 |