| NPI | 1053358838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 002684) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 2684) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-04-08 |