| NPI | 1063278562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374700000X Technician (Licence: FL 611-11973) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: FL 611-11964) |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2024-04-08 |