| NPI | 1568092872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TN 272280) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TN 20-104) |
| Enumeration Date | 2020-01-26 |
| Last Update Date | 2023-12-11 |