| NPI | 1508646597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: FL RN9584400) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: FL 19-456) |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |