| NPI | 1558507319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: AZ 00-211) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO 83801) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2008-12-29 |