| NPI | 1275850802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 174400000X Specialist (Licence: CO SA0001520) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2014-11-05 |