| NPI | 1013280858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA 317) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 006363) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2016-04-16 |