| NPI | 1821874470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other Surgical Technologist |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-09-07 |