| NPI | 1205118635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 006442) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: SC AA 25) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2016-02-26 |