| NPI | 1356870919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 78) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA384) |
| 367H00000X Anesthesiologist Assistant (Licence: SC MAA78) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2024-08-02 |