| NPI | 1265873608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: NJ 25MS00014100) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: FL DI 43353) |
| 291U00000X Clinical Medical Laboratory (Licence: NY AMJAM1) | |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2015-07-02 |