| NPI | 1740531961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00643) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 4034) |
| 363AS0400X Physician Assistant, Surgical (Licence: TX 4034) | |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2021-08-12 |