| NPI | 1124491998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000050) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: WI 152) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2022-09-26 |