| NPI | 1811179864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246QM0706X Spec/Tech, Pathology, Medical Technologist |
| Additional Taxonomies | 246RM2200X Technician, Pathology, Medical Laboratory |
| Enumeration Date | 2007-12-01 |
| Last Update Date | 2007-12-01 |