| NPI | 1053458125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: TX SA00086) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX SA00086) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2022-07-08 |