| NPI | 1124369103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: GA 4102) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: TX 4102) |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist | |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: GA 4102) | |
| Enumeration Date | 2013-03-15 |
| Last Update Date | 2023-05-23 |