| NPI | 1366689283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238.000278) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238.000278) | |
| 363AS0400X Physician Assistant, Surgical (Licence: VA 2906) | |
| Enumeration Date | 2009-01-14 |
| Last Update Date | 2014-02-18 |