| NPI | 1700535630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 208501) |
| Additional Taxonomies | 225500000X Specialist/Technologist |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2022-05-12 |