| NPI | 1750703187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1660) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2014001131) |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2025-08-29 |