| NPI | 1235788753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: HI MD-12851) | |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2024-10-31 |