| NPI | 1720637796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA529) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL AA529) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2025-10-06 |