| NPI | 1528220019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 1069) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 168794) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2018-07-20 |