| NPI | 1902478654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: CA A203664) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MO 2021022113) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2026-06-08 |