| NPI | 1447557251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: CA DRN68) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: FL DI43339) |
| 291U00000X Clinical Medical Laboratory (Licence: NY MORRM7) | |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2014-04-11 |