| NPI | 1235518358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: NC 2018-00704) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 211046) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2021-08-11 |