| NPI | 1831695618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000524) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000036A) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2025-11-03 |