| NPI | 1033780705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 247000000X Technician, Health Information (Licence: MI 218042) |
| Enumeration Date | 2021-07-05 |
| Last Update Date | 2021-07-05 |