| NPI | 1659028090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: VA 0024186283) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001263425) |
| Enumeration Date | 2022-03-06 |
| Last Update Date | 2024-09-25 |