| NPI | 1952745101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000076A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2013015602) |
| 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000044) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2024-12-03 |