| NPI | 1568988632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 9909) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA397) |
| Enumeration Date | 2017-08-20 |
| Last Update Date | 2024-02-13 |