| NPI | 1639893621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: VA 0136000028) |
| Additional Taxonomies | 246ZX2200X Specialist/Technologist, Other, Orthopedic Assistant (Licence: VA 1206) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-10-03 |