| NPI | 1376879809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: NV 112380) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: NV 86492) |
| 247200000X Technician, Other | |
| Enumeration Date | 2009-10-17 |
| Last Update Date | 2009-10-17 |