| NPI | 1861112559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL 789) |
| 367H00000X Anesthesiologist Assistant | |
| 367H00000X Anesthesiologist Assistant (Licence: FL 789) | |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2025-06-17 |