| NPI | 1891177911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: FL ME143856) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 207549649) |
| Enumeration Date | 2015-06-25 |
| Last Update Date | 2025-03-11 |