| NPI | 1306583844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 32698161) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000152A) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2026-07-10 |