| NPI | 1760043152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: AL 50839) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 64183) |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2025-07-25 |