| NPI | 1891403291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67.000492) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000116A) |
| Enumeration Date | 2022-11-14 |
| Last Update Date | 2024-10-09 |