| NPI | 1952793465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: NM MD2016-0288) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: CA G72343) |
| Enumeration Date | 2015-02-21 |
| Last Update Date | 2016-11-04 |