| NPI | 1316656135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA799) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL AA799) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2025-02-18 |