| NPI | 1922354539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: TX FPF00001162) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 15593) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2021-01-04 |