| NPI | 1194963298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 005638) |
| Additional Taxonomies | 2279C0205X Respiratory Therapist, Registered Critical Care (Licence: GA 05449) |
| 367H00000X Anesthesiologist Assistant | |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2011-07-13 |