| NPI | 1639555022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: NC 1000-00918) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA 274) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2020-09-29 |