| NPI | 1427811074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2026013466) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000168A) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2026-10-12 |