| NPI | 1326832403 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: DC AA2000088) | 
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program | 
| Enumeration Date | 2025-04-05 | 
| Last Update Date | 2025-06-16 |