| NPI | 1265015572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: NM MD2024-1078) |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2026-05-15 |