| NPI | 1497307144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OK 23) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2020021670) |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2025-08-27 |