| NPI | 1881946689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 103) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NM AA2012-004) |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2025-01-30 |