| NPI | 1588016661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 114) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA358) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2023-08-25 |