| NPI | 1760985782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA437) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL AA437) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2025-03-27 |