| NPI | 1861565681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0101238553) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101238553) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2017-12-01 |