| NPI | 1306268750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: CT 72) |
| Additional Taxonomies | 227900000X Respiratory Therapist, Registered (Licence: CT 287) |
| Enumeration Date | 2014-01-18 |
| Last Update Date | 2014-01-18 |