| NPI | 1194137497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2019-08-27 |