| NPI | 1962864504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00960) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX SA00960) |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2024-12-02 |