NPI | 1770905804 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238000402) |
Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: IL 238000402) |
Enumeration Date | 2014-01-08 |
Last Update Date | 2014-01-08 |