| NPI | 1568074227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: GA RN180449) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: GA RN180449) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant | |
| 363AS0400X Physician Assistant, Surgical | |
| Enumeration Date | 2020-08-23 |
| Last Update Date | 2020-09-06 |