| NPI | 1942663364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME148534) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101271636) |
| 208D00000X General Practice (Licence: FL ME148534) | |
| Enumeration Date | 2016-04-02 |
| Last Update Date | 2026-06-23 |