| NPI | 1467878694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: CA c3214676) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: CA Cpt00018837) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2014-04-22 |