NPI | 1942663364 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: DC MTL60001614) |
Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101271636) |
208D00000X General Practice (Licence: FL ME148534) | |
Enumeration Date | 2016-04-02 |
Last Update Date | 2024-05-21 |