| NPI | 1467957829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2018016968) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IN 75000155A) |
| 367H00000X Anesthesiologist Assistant (Licence: SC 111) | |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2024-12-03 |