| NPI | 1447823075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 193-17) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000194A) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2024-11-08 |