| NPI | 1821855768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: IL 238000789) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: IL 238.000789) |
| Enumeration Date | 2024-03-05 |
| Last Update Date | 2024-05-17 |