| NPI | 1265403174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: GA 1421) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00070) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| 363AS0400X Physician Assistant, Surgical (Licence: GA 1421) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2022-06-21 |