| NPI | 1700198603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MI 4301101605) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: MS T-2342) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301101605) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2020-11-18 |