| NPI | 1396327995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 10924) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 32698104) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2022-10-25 |