| NPI | 1730592130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: NY 310867) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP03218) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2021-06-11 |