| NPI | 1104179704 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: MD 5000-609) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: MD 5000-609) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-10-19 |