| NPI | 1841689528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 75387) |
| Additional Taxonomies | 207ZF0201X Pathology, Forensic Pathology (Licence: FL 75387) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL 75387) | |
| Enumeration Date | 2015-01-17 |
| Last Update Date | 2015-01-17 |