| NPI | 1962719658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 129578) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 129578) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2018-05-17 |