| NPI | 1114635018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000210) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO pending) |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2023-03-29 |