| NPI | 1134479991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 1377) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA156) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2020-09-04 |