| NPI | 1669355103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: VA 0001189503) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0001189503) |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2026-07-21 |