| NPI | 1710721832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-06-24 |