| NPI | 1144965690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA773) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 13287) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2026-06-14 |