| NPI | 1871370965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA836) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL AA836) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2023-10-07 |