| NPI | 1497320683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000174) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX NCCAA32698098) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2024-04-29 |