| NPI | 1659414712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246QM0706X Spec/Tech, Pathology, Medical Technologist (Licence: 160722) |
| Additional Taxonomies | 246RM2200X Technician, Pathology, Medical Laboratory (Licence: 059595) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2025-09-11 |