| NPI | 1619399359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: TX SA00594) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: DC SA0052) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2019-07-26 |