| NPI | 1659190858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA1064) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WA AA70072721) |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2026-05-22 |