| NPI | 1538873807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 32698366) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000128A) |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2024-04-10 |