| NPI | 1225452550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TN 820) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: TN 820) |
| 363A00000X Physician Assistant (Licence: TN 820) | |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2018-03-29 |