| NPI | 1336523240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NC 2000-00036) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2025-04-10 |