| NPI | 1437640646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000187) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IN 75000050A) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: DC 25870258) | |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2022-09-07 |