| NPI | 1700541463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 184775) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 184775) |
| Enumeration Date | 2021-11-07 |
| Last Update Date | 2021-11-09 |