| NPI | 1891776282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246Z00000X Specialist/Technologist, Other (Licence: NV 00F-116) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2007-07-08 |