| NPI | 1104144070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2010-07-16 |