| NPI | 1144592304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy |
| Additional Taxonomies | 171W00000X Contractor |
| 251E00000X Home Health | |
| 291U00000X Clinical Medical Laboratory | |
| 311ZA0620X Custodial Care Facility, Adult Care Home | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2019-03-15 |