| NPI | 1063146256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 11194) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA NA) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2022-10-18 |