| NPI | 1508063728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 07-252) |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-04-20 |