| NPI | 1932248556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: CA CLF333109) |
| Additional Taxonomies | 261QR0200X Clinic/Center, Radiology (Licence: CA TG516) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2007-08-21 |