| NPI | 1023242526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1025) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL 1025) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2020-08-18 |