| NPI | 1952919482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 12049) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IN 75000062A) |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2024-01-11 |