| NPI | 1578055414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NJ 25IA12667000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: VA 0116037510) |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: VA 0116037610) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2025-09-24 |