| NPI | 1689837775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2020020930) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 5874) |
| 363A00000X Physician Assistant (Licence: WA PA10004213) | |
| 363AM0700X Physician Assistant, Medical (Licence: GA 5874) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2023-05-01 |