| NPI | 1154607893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2012-12-17 |