| NPI | 1588403802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC 789790159) |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2024-10-14 |