| NPI | 1760212989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA1055) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO pending) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2025-04-10 |