| NPI | 1609605534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 0000000) |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2024-08-09 |