| NPI | 1457600496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: ID FT5124843) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 3709) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KS 05-37875) | |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2018-10-09 |