| NPI | 1801444781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZA2600X Specialist/Technologist, Other, Art, Medical (Licence: AL Y2K9K6X5) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: AL 10040240) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2019-09-03 |