| NPI | 1730262148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: MA 53751) |
| Additional Taxonomies | 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: MA 53751) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-03-23 |