| NPI | 1497856686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: CO AS0015) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: CO AS0015) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2018-02-15 |