| NPI | 1467480830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: CA A69195) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: NY 224011) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2007-07-08 |