| NPI | 1851693550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 171R00000X Interpreter |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 08 - 104) | |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00496) | |
| Enumeration Date | 2010-12-01 |
| Last Update Date | 2015-03-19 |