| NPI | 1952712358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy |
| Additional Taxonomies | 171100000X Acupuncturist |
| 225700000X Massage Therapist (Licence: TX MT132983) | |
| 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician | |
| Enumeration Date | 2014-05-19 |
| Last Update Date | 2024-10-21 |