NPI | 1922763465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PR 1220) |
363AM0700X Physician Assistant, Medical (Licence: PR 1202) | |
Enumeration Date | 2021-10-31 |
Last Update Date | 2022-09-05 |