| NPI | 1548429293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: KY 1092229) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: KY SA165) |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2008-06-07 |