| NPI | 1578400354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: AZ 191544) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty (Licence: AZ 191544) |
| Enumeration Date | 2026-04-30 |
| Last Update Date | 2026-04-30 |