| NPI | 1871831453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: CA CPT00040181) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN 267760) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2013-01-16 |