| NPI | 1407516784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL 9637717) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 21-740) |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2023-08-07 |