| NPI | 1407656812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA1179) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2025025701) |
| Enumeration Date | 2025-03-14 |
| Last Update Date | 2026-01-12 |