| NPI | 1417360462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: 1108070014) |
| Additional Taxonomies | 291900000X Military Clinical Medical Laboratory |
| 291U00000X Clinical Medical Laboratory (Licence: HI 4830) | |
| 291U00000X Clinical Medical Laboratory (Licence: 44317) | |
| Enumeration Date | 2014-06-07 |
| Last Update Date | 2014-06-07 |