| NPI | 1023405784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000256) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2026-07-10 |