| NPI | 1023435500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 9529) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA000040) |
| 367H00000X Anesthesiologist Assistant (Licence: TX 1543) | |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2024-10-21 |