| NPI | 1134760580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA550) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 28512091) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2023-01-24 |