| NPI | 1407166838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 603-17) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA79) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2026-02-03 |