| NPI | 1336926138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 12168) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 12168) |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2024-04-08 |