| NPI | 1952994071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA942) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA2000013) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2024-09-27 |