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Individual
ALPHONSUS MADUWUBA AGBAERE
Active
Individual
ALPHONSUS MADUWUBA AGBAERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MT(ASCP)CLS(NCA)
Taxonomy
Speciality
Code
Description
License number
State
246RM2200X
Medical Laboratory Technician
163311
GA
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
163311
GA
Other
Enumeration date
04/28/2009
Last updated
04/28/2009
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