| NPI | 1407152333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician (Licence: NY 014999) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032031) |
| 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician (Licence: 226448) | |
| Enumeration Date | 2011-02-10 |
| Last Update Date | 2016-04-13 |