| NPI | 1487215513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA531) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL AA531) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2021-01-09 |