| NPI | 1588546881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 13725) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2025038227) |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2026-02-08 |