| NPI | 1992400188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 789789880) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2024-08-20 |