| NPI | 1609016336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: TN 22459) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: PR 3653) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2009-02-20 |