| NPI | 1891363388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 5151017078) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 289493) |
| 208D00000X General Practice (Licence: MA 289493) | |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2024-06-24 |