| NPI | 1043600836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: WA ST00001996) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: WA XT00004606) |
| 247200000X (Licence: WA MA00153098) | |
| 376K00000X Nurse's Aide (Licence: WA NA00153098) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2015-01-30 |