| NPI | 1508414848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 619-17) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2026-05-19 |