| NPI | 1528486107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other Orthopedic Assistant (Licence: 1192) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-03-21 |