| NPI | 1790135457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 82-17) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000131) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2023-06-07 |