| NPI | 1154718005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: WI 94-321) |
| Additional Taxonomies | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MN 65094) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM R-13-2015) | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2020-07-29 |