NPI | 1346993987 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: GA 207716) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: GA 207716) |
Enumeration Date | 2022-02-03 |
Last Update Date | 2022-02-03 |