| NPI | 1104277680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO 94) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: SC TL51) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2019-03-28 |