| NPI | 1790659381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246QL0900X Spec/Tech, Pathology, Laboratory Management |
| Additional Taxonomies | 183700000X Pharmacy Technician |
| Enumeration Date | 2025-10-06 |
| Last Update Date | 2025-10-06 |