| NPI | 1629617295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0105X Pathology, Clinical Pathology/Laboratory Medicine (Licence: WI 103254-875) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64260) |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: OH 35C.001422) | |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2025-12-06 |