| NPI | 1265079586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2023018543) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000090A) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2023-12-09 |