| NPI | 1780810754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: NC 202338) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NC 103987) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2010-06-03 |