| NPI | 1730429150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LC0200X Anesthesiology Critical Care Medicine (Licence: GA 6914) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 367H00000X Anesthesiologist Assistant (Licence: GA 6914) | |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2023-11-02 |