| NPI | 1164610127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO 64) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 5177) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2019-03-25 |