| NPI | 1740616564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000072A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1664) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2021-02-05 |