| NPI | 1205188737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 006600) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: GA 6600) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2014-03-03 |