| NPI | 1417228909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: AZ L18709787) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: OR 454110172) |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2014-08-12 |