| NPI | 1477049666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: FL 18-280) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2022-04-07 |