| NPI | 1093265969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NM AA2019-003) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000197) |
| 367H00000X Anesthesiologist Assistant (Licence: WI 89) | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2025-01-16 |