| NPI | 1578793527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2009-07-23 |