NPI | 1114590254 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 32698019) |
Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2025017596) |
Enumeration Date | 2021-07-16 |
Last Update Date | 2025-06-05 |