| NPI | 1568915049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA339) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000340) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2026-02-19 |