| NPI | 1871224923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000111A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 210-17) |
| Enumeration Date | 2022-06-20 |
| Last Update Date | 2022-08-10 |