| NPI | 1881094217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: CA CPT 00019019) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2014-10-03 |