| NPI | 1578445292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA1079) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL AA1079) |
| Enumeration Date | 2025-07-23 |
| Last Update Date | 2025-08-11 |