| NPI | 1962418400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: GA 038767) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: GA 038767) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2010-08-10 |