NPI | 1205854437 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: GA 002169) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 002169) |
Enumeration Date | 2006-07-17 |
Last Update Date | 2010-10-01 |