| NPI | 1972061067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IN 75000043A) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NM AA2022-005) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2023-07-06 |