| NPI | 1639745458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: CO SA.0002781) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: CO ST.0005969) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2021-06-02 |