| NPI | 1457631129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: TX FPF00000470) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 4164) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2020-01-09 |