| NPI | 1326685991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 19-469) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| 363AS0400X Physician Assistant, Surgical (Licence: 19-469) | |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2024-03-22 |