| NPI | 1942815063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 170) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: SC 117) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2026-08-18 |