| NPI | 1861710089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 10980) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT-0000046) |
| 367H00000X Anesthesiologist Assistant (Licence: MO 2022036871) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2026-01-06 |