| NPI | 1104867993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67-000117) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000060) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2023-02-01 |