| NPI | 1578795092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: IL 238.000252) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: VA 3397) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IL 238.000252) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2014-02-18 |