| NPI | 1871614586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: LA 1169) |
| Additional Taxonomies | 363AS0400X Physician Assistant Surgical (Licence: LA 1116) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2021-11-18 |