| NPI | 1700557188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| 246RP1900X Technician, Pathology, Phlebotomy | |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2024-11-02 |