| 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 |