| NPI | 1710527510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: KY SA342) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PR 2618) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2026-02-05 |