| NPI | 1396286399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 526) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000292) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2023-04-13 |