| NPI | 1114044542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 151900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 808232) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: 100964) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2015-09-23 |