| NPI | 1154415404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA85) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 001965) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2011-11-04 |