| NPI | 1629577531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 574862) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 574862) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2021-11-18 |