| NPI | 1346237609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 141) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 3700) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2025-09-10 |