| NPI | 1992087837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 3691) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: FL 515573) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2011-09-16 |