| NPI | 1124392964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238000322) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238000322) |
| Enumeration Date | 2012-02-24 |
| Last Update Date | 2012-02-24 |