| NPI | 1588026538 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 75423-20) | 
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: MA 281760) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-28 | 
| Last Update Date | 2025-01-09 |