| NPI | 1194801837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| Additional Taxonomies | 174400000X Specialist |
| 211D00000X Assistant, Podiatric | |
| 246Y00000X Spec/Tech, Health Info | |
| 247200000X Technician, Other | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-10-31 |