| NPI | 1932683034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 122) |
| 207L00000X Anesthesiology (Licence: FL 722) | |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2024-07-24 |