| NPI | 1053696682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NM AA2016-003) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NC 1142) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2023-11-01 |