| NPI | 1770570327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 2331) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000143) |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2026-03-13 |