| NPI | 1962103689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 247ZC0005X Pathology, Clinical Laboratory Director, Non-physician |
| 261QC1500X Clinic/Center, Community Health | |
| 261QH0100X Clinic/Center, Health Services | |
| 291U00000X Clinical Medical Laboratory | |
| 246RM2200X Technician, Pathology, Medical Laboratory | |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2023-03-10 |