| NPI | 1093591737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 538) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX na) |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2025-05-07 |