| NPI | 1790189140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA442) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 007353) |
| Enumeration Date | 2014-10-14 |
| Last Update Date | 2025-02-03 |