| NPI | 1134704398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000156A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000404) |
| Enumeration Date | 2021-03-09 |
| Last Update Date | 2026-07-22 |