| NPI | 1407210404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZC0006X Pathology, Clinical Pathology (Licence: TX S4396) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX S4396) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: TX K5474) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2022-10-04 |