| NPI | 1487908174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: FL 12-190) |
| Additional Taxonomies | 208600000X Surgery (Licence: ZZ 43339) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2019-02-25 |