| NPI | 1659676583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN.0204892) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2016-11-03 |