| NPI | 1538439823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: TX 129934) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist (Licence: TX 129934) |
| Enumeration Date | 2012-01-04 |
| Last Update Date | 2014-02-18 |