| NPI | 1174761878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 239514) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 232217) |
| 207ZD0900X Pathology, Dermatopathology (Licence: MA 239514) | |
| Enumeration Date | 2009-02-03 |
| Last Update Date | 2012-04-11 |