| NPI | 1356983977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2022030647) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OK 25) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2024-04-08 |