| NPI | 1518193994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238.000023) |
| Additional Taxonomies | 246X00000X Spec/Tech, Cardiovascular (Licence: IL 238.000023) |
| Enumeration Date | 2009-05-30 |
| Last Update Date | 2009-05-30 |