| NPI | 1598591968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX AA991) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 621-17) |
| 367H00000X Anesthesiologist Assistant (Licence: FL AA991) | |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2026-07-15 |