| NPI | 1467969758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA643) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000026A) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2021-05-13 |