| NPI | 1083636971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA-958) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: OH 67-000060) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2024-12-30 |