| NPI | 1861070039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology Anatomic Pathology & Clinical Pathology (Licence: VA 0101277671) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101277671) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-30 |
| Last Update Date | 2025-07-16 |