| NPI | 1225580855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 16666) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2016-10-31 |
| Last Update Date | 2017-07-13 |