| NPI | 1790204329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA411) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000195A) |
| Enumeration Date | 2017-09-14 |
| Last Update Date | 2024-11-21 |