| NPI | 1689797482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: TX PF0302) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX PF0302) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2008-06-23 |