| NPI | 1073079182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 91) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 9623) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2022-01-20 |