| NPI | 1184393845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NV AA03) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OK 32698013) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2024-08-30 |