| NPI | 1770802928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: AZ 44593) |
| Additional Taxonomies | 207ZP0213X Pathology, Pediatric Pathology (Licence: CA A107791) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2015-07-02 |