| NPI | 1295535607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO pending) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA1171) |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2025-10-31 |