NPI | 1124562426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO 18-0918) |
Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
Enumeration Date | 2016-12-06 |
Last Update Date | 2022-04-21 |