NPI | 1245686518 |
---|---|
Other Name | JAKE A DEVORE |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00729) |
Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: KS 142172) |
Enumeration Date | 2016-05-05 |
Last Update Date | 2020-09-10 |