| NPI | 1174808844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO 103) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: TX 1280) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2019-05-23 |