| NPI | 1790084598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: VA 0101241506) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: TX Q6660) |
| 207ZP0007X Pathology, Molecular Genetic Pathology (Licence: MO 2014011291) | |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2016-06-06 |