| NPI | 1255066122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2023000420) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA 056859477) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-07-23 |
| Last Update Date | 2023-01-11 |