| NPI | 1548583032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: CA MTA 43288) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: HI 4529) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2010-03-11 |