| NPI | 1720225253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX J3544) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX J3544) |
| 208D00000X General Practice (Licence: TX J3544) | |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2009-01-21 |