| NPI | 1356720387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NH 18713) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MA 269567) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 256001) | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: ME MD22122) | |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2018-06-11 |