| NPI | 1053662023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 54) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1416) |
| Enumeration Date | 2012-10-01 |
| Last Update Date | 2017-03-01 |