| NPI | 1770927907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: CA CPT45136) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: CA 00238371) |
| 376K00000X Nurse's Aide (Licence: CA 00770416) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2013-04-18 |