| NPI | 1972905248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Additional Taxonomies | 1710I1003X Military Health Care Provider Independent Duty Medical Technicians |
| 247200000X Technician, Other | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |