| NPI | 1023680188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 246QL0901X Spec/Tech, Pathology, Laboratory Management, Diplomate |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2021-12-01 |