| NPI | 1043401292 |
|---|---|
| Former Name | TIMOTHY SHAWN DEHART |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 87458) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 87458) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2015-11-12 |