| NPI | 1235360959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 238000232) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2019-11-20 |