| NPI | 1376798900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: AZ 139058) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7978) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2014-07-22 |