Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | CA |
NPI | 1154811297 |
---|---|
Provider Name | Patrick Lee |
First Address | Torrance, CA 90248 |
Second Address | Torrance, CA 90248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 15/05/2018 |