| NPI | 1750615456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS018941) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist | |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2021-09-13 |