| NPI | 1124617634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 10180) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA806) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2023-04-17 |