| NPI | 1770398745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 789790580) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-02-07 |
| Last Update Date | 2025-05-21 |