| NPI | 1154671394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 171W00000X Contractor (Licence: IL 238.000298) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2023-03-27 |