| NPI | 1508829409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000004A) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-02-22 |