| NPI | 1639799968 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NH R4561) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: UT 12404261-1205) | 
| Enumeration Date | 2020-04-16 | 
| Last Update Date | 2025-07-11 |