| NPI | 1780930354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: VA 0101254544) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101254544) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2023-10-23 |