| NPI | 1902394836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000058A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2018016969) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-03-03 |