| NPI | 1952716276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 1412) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 1412) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2018-07-31 |