| NPI | 1619296274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00575) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX 381) |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2020-03-28 |