| NPI | 1467725275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 13-309) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 981) | |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2022-06-15 |