| NPI | 1750631131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: CT 68891) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: TN MD52583) | |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2021-07-15 |