| NPI | 1033801832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: DC AA2000047) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: VA 789789819) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-07-28 |