| NPI | 1457011223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 13259) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA701) |
| Enumeration Date | 2021-12-21 |
| Last Update Date | 2025-07-22 |