| NPI | 1427760057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2023003008) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO pending) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2024-11-18 |