| NPI | 1124429022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: WI 49-017) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2014031836) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2022-07-21 |