| NPI | 1235784059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: VA 0110006875) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: VA 0110006875) |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2023-10-13 |