| NPI | 1669064598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 32697896) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA2000006) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2022-08-10 |