| NPI | 1952799140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246RP1900X Technician, Pathology, Phlebotomy (Licence: FL 640828030014) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: FL 640828030014) |
| 374700000X Technician (Licence: FL 640828030014) | |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2020-03-25 |