| NPI | 1154865269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 909992) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: NY 246ZC0007X) |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2024-06-10 |