| NPI | 1528231685 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME112341) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2008-04-10 | 
| Last Update Date | 2025-09-16 |