| NPI | 1548250707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00609) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: TX 811) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2017-07-18 |