| NPI | 1922835347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MO pending) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA Pending) |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-11-24 |