| NPI | 1093062028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 112) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2022-08-18 |