| NPI | 1194837724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA260) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 4631) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-04-26 |