| NPI | 1396736070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: KY SA081) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 0000097) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2008-03-21 |