| NPI | 1497866263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00018) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: CO F01177) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO F01177) | |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00018) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-10-08 |