| NPI | 1285489815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 2147483647) |
| Enumeration Date | 2024-04-18 |
| Last Update Date | 2024-06-05 |