| NPI | 1164667820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: OK 111647) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OK L 0053790) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2008-12-10 |