| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
|
| Primary Taxonomy | 247ZC0005X Pathology Clinical Laboratory Director, Non-physician |
| Additional Taxonomies | 246QH0000X Specialist/Technologist, Pathology Hematology |
| 246QH0600X Specialist/Technologist, Pathology Histology |
| 246QI0000X Specialist/Technologist, Pathology Immunology |
| 246QL0900X Specialist/Technologist, Pathology Laboratory Management |
| 246QM0706X Specialist/Technologist, Pathology Medical Technologist |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2016-12-12 |