| NPI | 1902245467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 73425) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-09913) |
| 207R00000X Internal Medicine (Licence: IA R-9841) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2023-10-17 |