| NPI | 1730519836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 246Z00000X Specialist/Technologist, Other (Licence: FL 04-178) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2023-08-10 |