| NPI | 1285009803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00635) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00635) |
| 208600000X Surgery (Licence: TX SA00635) | |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: TX SA00635) | |
| Enumeration Date | 2015-12-08 |
| Last Update Date | 2018-06-16 |