| NPI | 1881478865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA870) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-11-01 |