| NPI | 1154442606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35-042327) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: OH 35-042327) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2025-09-11 |