| NPI | 1124636527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 9948) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363AM0700X Physician Assistant Medical (Licence: GA 9948) | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2022-09-27 |