NPI | 1467164830 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 32698365) |
Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA1059) |
Enumeration Date | 2022-12-19 |
Last Update Date | 2025-06-11 |