| NPI | 1891970224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00330) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX NSAA certified #2235) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00330) | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2016-01-14 |