| NPI | 1255053278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000140A) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 761) |
| 367H00000X Anesthesiologist Assistant (Licence: TX 32698309) | |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2023-08-16 |