| NPI | 1194058883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: NM 04209369) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM RN-69832) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2009-09-11 |