| NPI | 1053694976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: MI 1227) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 2011032475) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2018-12-13 |