| NPI | 1194265371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110005673) |
| Additional Taxonomies | 207LC0200X Anesthesiology Critical Care Medicine (Licence: VA 0110005673) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2023-09-18 |