| NPI | 1174083943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000042A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MI 28513404) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-05-14 |