| NPI | 1003515271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: TN 5572) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2023-02-27 |
| Last Update Date | 2024-04-01 |