| NPI | 1932760113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AL MD.45762) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019020541) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2023-10-24 |