| NPI | 1710389457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NC 2019-01355) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2020-10-01 |