| NPI | 1124482104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0213X Pathology, Pediatric Pathology (Licence: OH 35.135142) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MS 962-L) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2020-10-01 |