| NPI | 1053678367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246QM0706X Spec/Tech, Pathology, Medical Technologist (Licence: MT 1561) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: MT RTS-LPH-LIC-3126) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2012-04-12 |