| NPI | 1124564620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: FL 15-122) |
| Additional Taxonomies | 246RP1900X Technician, Pathology Phlebotomy (Licence: FL 20141217405) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |