| NPI | 1972622595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00324) |
| Additional Taxonomies | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX SA00324) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 2945) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2016-08-13 |