| NPI | 1164799102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician (Licence: CT Certificate No. 423) |
| Additional Taxonomies | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician (Licence: NY CQP51389) |
| Enumeration Date | 2011-11-18 |
| Last Update Date | 2011-11-18 |