| NPI | 1922386028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ZP0101X Pathology, Anatomic Pathology (Licence: FL ME130418) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0101X Pathology, Anatomic Pathology (Licence: NY 280085) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2016-11-17 |