| NPI | 1578797643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1710I1002X Military Health Care Provider, Independent Duty Corpsman |
| Additional Taxonomies | 246QC2700X Spec/Tech, Pathology, Cytotechnology |
| 246QM0706X Spec/Tech, Pathology, Medical Technologist | |
| Enumeration Date | 2009-05-05 |
| Last Update Date | 2009-05-05 |