| NPI | 1245897388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA717) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 9527) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-23 |
| Last Update Date | 2022-02-10 |