| NPI | 1043649197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA452) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant |
| 367H00000X Anesthesiologist Assistant (Licence: DC AA000092) | |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2018-08-16 |