| NPI | 1003936618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-06-11 |