| NPI | 1184136079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA438) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL AA438) |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2019-10-07 |