| NPI | 1134751878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: TX 32697803) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: 32697803) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2022-06-04 |