| NPI | 1164169983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: WI 87126) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OK 39512) | |
| Enumeration Date | 2022-05-13 |
| Last Update Date | 2026-05-17 |