| NPI | 1609357037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: SC 67) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA459) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2023-06-26 |