| NPI | 1780243451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2025024808) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000041A) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2025-07-08 |