| NPI | 1164268355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA1131) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL 456457381) |
| Enumeration Date | 2024-07-08 |
| Last Update Date | 2025-10-22 |