| NPI | 1083468615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: FL 22-229) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9655544) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2025-01-30 |