| NPI | 1750954020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 12449) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000088A) |
| 367H00000X Anesthesiologist Assistant (Licence: FL 828) | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2024-07-18 |