| NPI | 1265208375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2025-10-29 |