| NPI | 1073395232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: pending) |
| Enumeration Date | 2023-10-20 |
| Last Update Date | 2024-05-23 |