| NPI | 1760920367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX SA00468) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1151233) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2026-03-12 |