| NPI | 1720094782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX H8180) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX H8180) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2011-12-14 |