| NPI | 1841495587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301090518) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI 4301090518) |
| 208D00000X General Practice (Licence: MI 5315032210) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2009-12-15 |