| NPI | 1962553396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 174400000X Specialist (Licence: DC SA0115) |
| Enumeration Date | 2007-01-14 |
| Last Update Date | 2022-01-29 |