| NPI | 1316501620 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NY 338893) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CT 077421) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-23 | 
| Last Update Date | 2025-08-06 |