| NPI | 1144829284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 174400000X Specialist (Licence: WI 20-264) |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2020-10-20 |