| NPI | 1447459854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MD lp49426) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: MD 3077) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2022-02-25 |