| NPI | 1457099772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: FL 171240555) |
| Additional Taxonomies | 253J00000X Foster Care Agency (Licence: FL 171240555) |
| Enumeration Date | 2022-05-25 |
| Last Update Date | 2022-05-25 |