| NPI | 1639369663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2015-03-18 |