| NPI | 1366952095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000153A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000312) |
| Enumeration Date | 2017-10-09 |
| Last Update Date | 2024-01-02 |