| NPI | 1104661438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 172A00000X Driver (Licence: SC 090476641) |
| 2472E0500X Technician, Other, EEG | |
| 374700000X Technician | |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-06-27 |