| NPI | 1710448121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZC0006X Pathology, Clinical Pathology (Licence: MA 279748) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2022-12-16 |