| NPI | 1588281547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ 298022) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: AZ E90833309) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: 5420) | |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2023-11-01 |