| NPI | 1750315958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MO 2010014000) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 5101017047) |
| 208D00000X General Practice (Licence: HI DOS 1120) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-08-11 |