| NPI | 1265703474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: TX PF1057) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: CO 166637) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2016-06-16 |