| NPI | 1073942561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1612) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 37) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2022-05-19 |