| NPI | 1649794876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZD0900X Pathology, Dermatopathology (Licence: IL 125079219) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2022-05-18 |