| NPI | 1962910133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000049A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 111) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2025-12-05 |