| NPI | 1720336548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000180A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2012029911) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2024-07-15 |