| NPI | 1629895883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000190A) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IN 75000190A) |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-10-11 |