| NPI | 1053765800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0213X Pathology, Pediatric Pathology (Licence: CA 20A18800) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2022-06-20 |