| NPI | 1316202096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KS 0440684) |
| Additional Taxonomies | 207ZH0000X Pathology, Hematology (Licence: KS 0440684) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63165) | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2019-05-15 |