| NPI | 1083865711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA29) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 5458) |
| 367H00000X Anesthesiologist Assistant (Licence: GA 941) | |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2024-01-18 |