| NPI | 1033083613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: GA 20240917142142) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: GA 20240917142141) |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-27 |