| NPI | 1922314962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 10-213) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX 10-213) |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2022-01-13 |