| NPI | 1730754490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 10631) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO pending) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2023-06-26 |