| NPI | 1619437456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZF0201X Pathology, Forensic Pathology (Licence: FL OS20024) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL OS20024) | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2023-07-12 |