| NPI | 1356689152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246QM0706X Spec/Tech, Pathology, Medical Technologist (Licence: 25357723) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: MA 22D2047480) |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2013-03-08 |