| NPI | 1912507161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology Phlebotomy |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 3747A0650X Technician Attendant Care Provider | |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2024-10-08 |