| NPI | 1144848649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA584) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: VT 135-0000069) |
| Enumeration Date | 2020-07-10 |
| Last Update Date | 2023-03-06 |