| NPI | 1760825491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: GA 080545) |
| Additional Taxonomies | 207ZP0101X Pathology, Anatomic Pathology (Licence: GA 80545) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2018-07-03 |