| NPI | 1346531266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VT 060.0003999) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: PA MD453819) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: ME MD21060) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2016-04-19 |