| NPI | 1194954545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00444) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 115370) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00444) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2020-01-28 |