| NPI | 1780303925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA756) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL 32698244) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2024-05-22 |