# ALPHONSUS MADUWUBA AGBAERE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1760626279
- **Gender:** Man
- **Credential:** MT(ASCP)CLS(NCA)

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 246RM2200X | Medical Laboratory Technician | 163311 | GA | — |
| 247ZC0005X | Clinical Laboratory Director (Non-physician) | 163311 | GA | Yes |

## Other

- **Enumeration date:** 04/28/2009
- **Last updated:** 04/28/2009