| NPI | 1629356647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: CO SA.0001276) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0200006) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2016-05-10 |