| NPI | 1518536291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 32697893) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000405) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2023-08-16 |