| NPI | 1114199809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00387) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 08-120) | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00387) | |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2021-01-04 |