| NPI | 1932691276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000331) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC 99) |
| Enumeration Date | 2018-06-02 |
| Last Update Date | 2026-06-01 |