| NPI | 1255749529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NM AA2014-007) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NM 92-223) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2024-12-30 |