| NPI | 1285021071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZX2200X Specialist/Technologist, Other Orthopedic Assistant (Licence: 913) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: 913) |
| 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: 913) | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2022-01-19 |