| NPI | 1003141292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA54) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 005637) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2010-10-05 |