| NPI | 1912712365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: WI 25-146) |
| Enumeration Date | 2025-02-12 |
| Last Update Date | 2025-02-28 |