| NPI | 1891275855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 10794) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| 367H00000X Anesthesiologist Assistant (Licence: FL AA463) | |
| 367H00000X Anesthesiologist Assistant (Licence: IN 75000134A) | |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2023-08-14 |