| NPI | 1417729419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL 1207) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2024020857) |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2026-08-12 |