| NPI | 1598054710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: CT 07D0995237) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2019-02-26 |