| NPI | 1689920175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00483) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX SA00483) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 136982) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2021-11-23 |