| NPI | 1881944957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO 2023018541) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL 1442) |
| Enumeration Date | 2012-09-14 |
| Last Update Date | 2025-10-13 |