| NPI | 1154713592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZC0006X Pathology, Clinical Pathology (Licence: MT MED-PHYS-LIC-105092) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2022-10-31 |