| NPI | 1790051134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 78172) |
| Additional Taxonomies | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: NE 27995) |
| 208D00000X General Practice (Licence: NE 27995) | |
| Enumeration Date | 2012-03-29 |
| Last Update Date | 2024-09-02 |