| NPI | 1316578628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 157-17) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2024-07-03 |