| NPI | 1720162167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: CA C56122) |
| Additional Taxonomies | 207ZP0007X Pathology, Molecular Genetic Pathology (Licence: CA C56122) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CA C56122) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-11-22 |