| NPI | 1013241934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 005687) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 5687) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2026-06-15 |