| NPI | 1548883606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: RI DO01271) |
| Additional Taxonomies | 207ZP0213X Pathology Pediatric Pathology (Licence: MA 1018915) |
| 208D00000X General Practice (Licence: RI DO01271) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-05-24 |
| Last Update Date | 2025-05-09 |