| NPI | 1346781705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: WI 136) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 136105) |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2017-03-17 |