| NPI | 1194426767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: KY B6P44F8Q3) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MO 134849) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-03-13 |