| NPI | 1801894738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR C4336) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: AR C4336) |
| 207ZP0105X Pathology Clinical Pathology/Laboratory Medicine (Licence: AR C4336) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2007-07-18 |