| 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 |