| NPI | 1720643687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: OH 35.155740) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM MD2025-0160) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2026-04-08 |