| NPI | 1184465502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO Pending) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2025-07-17 |