| NPI | 1457138950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 24-298) |
| Additional Taxonomies | 1744R1102X Specialist, Research Study |
| 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant | |
| 363AS0400X Physician Assistant, Surgical (Licence: 24-298) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2024-06-07 |