| NPI | 1972303709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 13253) |
| Enumeration Date | 2025-03-19 |
| Last Update Date | 2026-08-04 |