| NPI | 1194248385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL 731) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 8461) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2023-11-12 |