| NPI | 1588918270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: DC SA0078) |
| Enumeration Date | 2012-11-01 |
| Last Update Date | 2015-01-22 |