| NPI | 1881144756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 16-480) |
| Additional Taxonomies | 246QM0706X Spec/Tech, Pathology, Medical Technologist (Licence: NY 016191) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2020-12-01 |