| NPI | 1538587357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: KY 53889) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MA 274057) | |
| 207ZP0213X Pathology, Pediatric Pathology (Licence: KY 53889) | |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2020-08-11 |