| NPI | 1063182384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 12599) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000424) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2024-12-04 |