| NPI | 1710939939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TN 51516) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX M0107) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2014-06-05 |