| NPI | 1962630863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: AZ 47589) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ZP0102X Pathology, Anatomic Pathology & Clinical Pathology (Licence: MN 53205) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2013-06-04 |