| NPI | 1326478744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: 13-468) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: MS 13-468) |
| 363AS0400X Physician Assistant, Surgical (Licence: MS 13-468) | |
| Enumeration Date | 2013-11-21 |
| Last Update Date | 2013-11-21 |