| NPI | 1699317115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 9481) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: SC 97) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2022-08-12 |