| NPI | 1730500141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: MO 199140713) |
| Additional Taxonomies | 242T00000X Perfusionist (Licence: IL 214.000313) |
| 242T00000X Perfusionist (Licence: WI 125-18) | |
| Enumeration Date | 2014-01-02 |
| Last Update Date | 2014-01-02 |