| NPI | 1780794354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NY IQBAM1) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: NY IQBAM1) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |