| NPI | 1073925574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 21936488) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1692) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2025-07-14 |