| NPI | 1205360393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology Anatomic Pathology (Licence: NM MD2022-0328) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: PA MT214216) | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2022-06-08 |