| NPI | 1003230806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 007150) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1506) |
| Enumeration Date | 2014-02-13 |
| Last Update Date | 2014-05-09 |