| NPI | 1720182397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 13-480 certificate #) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: IA 161 NSOPAcertified) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2020-02-17 |