| NPI | 1003844721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 005412) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA432) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2023-12-14 |