| NPI | 1023889912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA932) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO 0000261) |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2024-10-14 |