| NPI | 1174809842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: OH 67000294) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: MO 2011034578) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2017-06-05 |