| NPI | 1649846379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA661) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 11503) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2024-08-24 |