| NPI | 1033591334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000066) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: DC AA000055) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2017-01-05 |