| NPI | 1750011268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: MA RN2365408) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: MA 20-298) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2022-06-16 |