| NPI | 1003245937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2024-10-10 |