| NPI | 1174875074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: CO ANT.0000199) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: FL AA259) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2023-06-07 |