| NPI | 1770612731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 597248) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 597248) |
| 246ZS0410X Specialist/Technologist, Other, Surgical Technologist (Licence: TX 597248) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-04-28 |