| NPI | 1780179333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA484) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000046A) |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2025-10-31 |