| NPI | 1558756379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: MD H0092565) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI L146135603313) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-11-02 |