| NPI | 1477540722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 3186) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA464) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2025-10-22 |