| NPI | 1700286200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000287) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000226A) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2025-11-10 |