| NPI | 1912066887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 02-172) |
| Additional Taxonomies | 174400000X Specialist |
| 208000000X Pediatrics (Licence: PR 16469) | |
| Enumeration Date | 2006-12-07 |
| Last Update Date | 2016-09-19 |