| NPI | 1598333189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 190-17) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 190-17) |
| 367H00000X Anesthesiologist Assistant (Licence: MO 2024036980) | |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2026-04-09 |