| NPI | 1043241854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 001733) |
| 367H00000X Anesthesiologist Assistant (Licence: OH 67000288) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-08-31 |