| NPI | 1548793409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 31037) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: TX 39020000X) |
| 208D00000X General Practice (Licence: TX NA) | |
| 208D00000X General Practice (Licence: NE 31037) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2023-08-10 |