| NPI | 1902462070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374700000X Technician (Licence: CA cpt00005469) |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory (Licence: CA cpt00005469) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2019-05-16 |