| NPI | 1518594126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301515702) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64308) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-05-13 |