| NPI | 1336199546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: CT 67636) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MD D0064256) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2021-06-11 |