| NPI | 1295045375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1168) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NM AA2023-0014) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2024-10-11 |