| NPI | 1124249032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA467) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 002850) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2019-02-08 |