| NPI | 1013915602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101058403) |
| Additional Taxonomies | 163WW0000X Registered Nurse, Wound Care (Licence: VA 0101058403) |
| 208600000X Surgery (Licence: NH 15835) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2022-08-23 |