| NPI | 1104692623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: VT 135-0000084) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO Unknown) |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2024-01-25 |