| NPI | 1013384205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: 2096) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 7751) |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2024-01-29 |