| NPI | 1649908112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: FL 16-724) |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: 16-724) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2022-08-11 |