| NPI | 1265852107 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: AL 35415) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AL 35415) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-18 | 
| Last Update Date | 2019-05-01 |