| NPI | 1659768976 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.034616) | 
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 1878) | 
| Enumeration Date | 2015-04-24 | 
| Last Update Date | 2025-05-15 |