| NPI | 1629365317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00576) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 123054) |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2023-06-09 |