| NPI | 1972516474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD073158L) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD073158L) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2022-12-20 |