| NPI | 1306965025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00335) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 03-132) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00335) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2014-02-18 |