| NPI | 1790601474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 1229641) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 1229641) |
| 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: TX 23-687) | |
| Enumeration Date | 2026-06-26 |
| Last Update Date | 2026-06-26 |