| NPI | 1770067746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 12132) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 2715470) |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2024-02-06 |